Medical Edge Newspaper Column

Understanding MS: The Children May Lead Us

June 25, 2006
DEAR MAYO CLINIC:
Can children get multiple sclerosis? If so, are their symptoms similar to those of adults? Do kids benefit from the same therapies? -- Rochester, Minn.

ANSWER:
Though surprising to many doctors, including pediatricians, children can and do develop multiple sclerosis (MS). This discovery is relatively recent, the culmination of evidence trickling in over years; therefore, the childhood disease has not yet been studied with scientific rigor.

While we estimate that about 10,000 children (under age 18) in the United States have MS -- out of approximately 350,000 patients in total -- the medical community can still say very little about incidence patterns, symptoms, disease progression and therapies associated with pediatric MS. Perhaps children with MS may ultimately be regarded just as miniature adults, or perhaps childhood MS may reveal itself to be quite distinct, requiring altogether different approaches. Only time will tell.

The great need for more data about pediatric MS prompted the U.S. National Multiple Sclerosis Society (NMSS) earlier this year to designate Mayo Clinic and five other medical centers as the first-of-its-kind network of Pediatric MS Centers of Excellence.

MS is a chronic, potentially debilitating disease that affects the central nervous system, comprising the brain and spinal cord. This illness has traditionally been thought to be immune-mediated -- the immune system attacks part of the body as if it's a foreign substance. In particular, antibodies and white blood cells are directed against proteins in the myelin sheathing that surrounds and insulates the nerves. This process causes inflammation and injury to the sheathing and, eventually, to the nerves themselves. It results in multiple areas of scarring (sclerosis), which can slow or block the nerve signals that control muscle strength, coordination, sensation and vision.

A competing theory of MS is that the myelin damage comes not from an autoimmune attack but from some environmental event such as infection with a virus early in one's life. In most patients, the resulting MS remains latent during childhood, typically manifesting itself during one's 20s or 30s. But given its occasional manifestation in children, in some cases that postinfection latency period may be very brief.

Interestingly, because children do not usually contract immune-mediated diseases, the fact that they can get MS may, by itself, strengthen the environmental theory. Moreover, given that children's histories are much shorter and less complex than those of adults, we may be better able to identify the actual environmental trigger, if one exists. And if, for argument's sake, a trigger of MS turns out to be a specific virus, developing a vaccine against it may be possible, much as was done for polio.

Under the NMSS grant, which totals $13.5 million over the next five years, clinicians and researchers from the six medical centers will collaborate to build a comprehensive database on childhood MS, not only regarding the potential environmental (or other) causes but on virtually all other aspects of this poorly understood condition. We also plan to educate the medical community in general, and pediatricians in particular, on what we learn about pediatric MS -- alerting them to its existence so that their own practices may contribute new data on the disease.

What about the children who have MS now? How might we best treat them to relieve their symptoms and modify the progression of their illness, while awaiting much-needed information? Answer: As best we can.

At present, physicians usually give children with MS the same kinds of drugs they administer to adults, only in proportionally smaller dosages. Then it's wait and see. Before too long, however, the intense study of childhood MS may yield benefits for children and adults alike.

-- Moses Rodriguez, M.D., Neurology, Mayo Clinic, Rochester, Minn.